Healthcare Provider Details

I. General information

NPI: 1841526423
Provider Name (Legal Business Name): NILDA SIMONE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 COLUMBUS AVE
NEW HAVEN CT
06519-1233
US

IV. Provider business mailing address

428 COLUMBUS AVE
NEW HAVEN CT
06519-1233
US

V. Phone/Fax

Practice location:
  • Phone: 203-503-3000
  • Fax: 203-506-3606
Mailing address:
  • Phone: 203-503-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberE55901
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: